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General NPI Number Information
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NPI Number | 1225127244
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Entity Type | Organization
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Legal Business Name | DEERFIELD DERMATOLOGY ASSOCIATES, LTD.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 707 LAKE COOK RD SUITE #280
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City | DEERFIELD
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State | IL
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Zip | 60015-4909
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Country | US
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Telephone | 847-480-0004
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Fax | 847-480-8707
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Provider Business Mailing Address
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Address Line | 707 LAKE COOK RD SUITE #280
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City | DEERFIELD
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State | IL
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Zip | 60015-4909
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Country | US
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Telephone | 847-480-0004
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Fax | 847-480-8707
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELISSA GOTTFREDSEN
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Credential |
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Telephone | 847-480-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 042-618435
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License Number State | IL
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